Project Summary/Abstract BACKGROUND: Health reform calls for more care coordination and management, which requires closer working relationships between physicians, hospitals, and health systems. Physician-system integration is hence one of the current key strategies for health systems. Despite the importance of physician-system integration, lack of data and inconsistent metrics have led to mixed conclusions about the contribution of integration to the overall success of a health system. The objectives of the proposed research are: 1) to begin defining what success means to different health systems, and 2) to then answer the following overarching research question: How is the success of integrated delivery systems affected by the degree and nature of physician-system integration? SPECIFIC AIMS: Aim 1 is to identify factors that organizations use to measure success of physician-system integration. Aim 2 is to conduct a systematic review of the literature on physician-system integration with the aim of refining and validating a conceptual model. Aim 3 is to determine whether the integrating structures between physician groups and health systems are associated with success. METHODS: We use a three-pronged approach. Aim 1 uses qualitative methods to interview up to 25 health system leaders in Washington State. Aim 2 is a systematic review with cluster analysis on literature published five years prior to and post the Accountable Care Act. Aim 3 uses mixed methods. We will use data from the American Hospital Association (AHA) Annual Survey, AHA IT Survey, AHA Survey of Care Systems and Payment, and American Hospital Directory (FY2009-FY2015) to examine the relationships between physician integrating structures, care coordination, and health system success. Variables will be informed by Aims 1 and 2. Findings will be compared to qualitative data from Aim 1. Throughout, we apply organizational theories (e.g., institutional theory, resource dependency theory, and transaction cost theory) to guide our conceptual framework and to build our hypotheses. IMPACT: The results of this research hope to inform strategies for implementing value-based care and achieving the Triple Aim. The identification of ?optimal? physician integrating structures can guide health systems in improving their performance and selecting their integration partners. Underlying physician integration has also been shown to help drive formation of accountable care organizations. The findings strive to be actionable and translatable to the problems that health systems face today.